Healthcare Provider Details

I. General information

NPI: 1033501549
Provider Name (Legal Business Name): NINA CHUKWU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2015
Last Update Date: 02/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 NE 35TH ST
OKLAHOMA CITY OK
73105-7607
US

IV. Provider business mailing address

929 NE 35TH ST
OKLAHOMA CITY OK
73105-7607
US

V. Phone/Fax

Practice location:
  • Phone: 405-774-6777
  • Fax:
Mailing address:
  • Phone: 405-774-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number37V540601214
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: